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Chronic Fatigue Symptoms: What To Look For

An image of a woman with glasses rubbing her right eyeChronic fatigue symptoms come in a wide range. The primary symptom of chronic fatigue syndrome is unexplainable fatigue that continues for six months and doesn't improve with rest. These symptoms indicate the presence of chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME). This collection of symptoms is also sometimes called systemic exertional intolerance disease (SEID).

Chronic fatigue symptoms can occur at any age, but most commonly happen to women in their mid-20s to mid-40s. Men also develop chronic fatigue symptoms but typically do not report them to their healthcare professionals at the same rate.

One to eight out of every 1,000 Americans may suffer from this chronic condition. And while it appears most often in certain age groups, people of any age can experience chronic fatigue symptoms. It seems to appear more frequently in African-Americans and Latinos, and less frequently among Asian Americans. However, it can occur in any ethnic group.

What is CFS?

Chronic fatigue syndrome describes a set of symptoms with extreme fatigue not alleviated by rest. In addition, it must occur for at least six months and other underlying medical conditions can’t explain it. Other symptoms discussed below also occur and must last for at least six months in order for doctors to identify CFS.

Chronic Fatigue Symptoms

Chronic fatigue symptoms bear a great resemblance to those of several other conditions. Therefore, a thorough workup should occur in order to rule out other conditions. The process of ruling out other conditions makes up the typical approach to the assessment of CFS. No specific laboratory test exists that will pinpoint CFS specifically.

Core Symptoms

Core symptoms for CFS include the following three primary symptoms.

Firstly, if you have CFS, you experience a significantly reduced ability to complete activities that you could typically do before the onset of symptoms. This happens along with the extreme fatigue that characterizes CFS. The fatigue experienced with CFS can be severe, was not a problem before onset of symptoms, does not result from any difficult activity, and you can’t recover from it with sleep.

Secondly, chronic fatigue symptoms worsen after mental or physical exertion that would not cause problems before the onset of symptoms. Post-exertional malaise (PEM) describes this symptom. People suffering from PEM often describe it as a ‘crash’ or ‘collapse’. It appears similar to the adrenal crash people suffering from Adrenal Fatigue Syndrome (AFS) can experience. With such a crash may come difficulty thinking, sleeplessness, headaches, sore throat, dizziness, and severe fatigue. It may require weeks or even months to recover from a crash. In the case of severe crashes, a person may become house-bound or even bed-bound. In addition, the triggers for crashes may elude you. Different triggers may bring on crashes at different times. For example:

  • Shopping for groceries may require a nap in the car before driving or calling for a ride.
  • Taking a shower may leave a person with PEM temporarily bed-bound.
  • Staying current with work may lead to evenings and weekends recovering.

Thirdly, people experiencing chronic fatigue symptoms may experience sleeplessness. Others will not feel refreshed after a full night’s sleep.

 Additional Required Symptoms

In addition to the three core symptoms above, one of the following symptoms must occur for an accurate assessment of CFS to occur.

  • Thinking and memory problems. These problems often appear as brain fog like that with AFS. Concentration, thinking, and remembering all seem extra difficult.
  • Symptoms worsen while standing or sitting upright. Also known as orthostatic hypotension. This is similar to symptoms that occurs with dysregulation of the Cardionomic circuit of the body's stress response mechanism. Feeling weak, lightheaded, or about to faint while standing can also occur.

Other Common Chronic Fatigue Symptoms

Many people experiencing chronic fatigue symptoms also deal with the following symptoms:

  • Pain of unknown origin, including muscle aches, joint pain, or headaches
  • Muscle weakness
  • Frequent sore throat
  • An image of a woman sitting with groceries trying to catch her breathShortness of breath
  • Chills and night sweats
  • Digestive issues
  • Allergies
  • Food sensitivities
  • Light, noise, and chemical sensitivities
  • Irregular heartbeat

Many of these secondary symptoms bear a strong likeness to those experienced by people suffering from AFS or dysregulation of circuits in body's stress response.

Related Conditions: AFS and NEM Dysregulation

Adrenal Fatigue Syndrome (AFS) is a health condition similar to CFS that results from chronic or severe stress. It begins with stress of any kind activating your adrenal glands to release cortisol, a stress-fighting hormone, to deal with the effects of stress. Ideally, cortisol handles these effects. However, if stress becomes chronic, your adrenals may become fatigued and unable to produce sufficient cortisol. This is the beginning of AFS. Symptoms start as vague but can worsen in severity to the point of becoming debilitating.

The NeuroEndoMetabolic (NEM) stress response is a model that describes how your body responds to continuing stress. This mechanism consists of several interconnected organs and systems, organized into circuits, that work to keep your body in balance. However, chronic stress can lead to dysregulation of its six circuits. Because these circuits work in an inter-related manner, what affects one affects others. This is how dysregulation can lead to varied and seemingly disconnected symptoms.

Other Related Physical Conditions and CFS

Accurate assessment of chronic fatigue symptoms requires your healthcare professional to rule out other conditions that may cause them. Currently, no laboratory tests exist that definitively point to CFS as the cause of your symptoms.

In your workup, your healthcare professional will ask about other illnesses and conditions you may experience. Some of these include:

  • Heart disorders
  • Sleep apnea or other sleep disorders
  • Cancer
  • Hepatitis B or C
  • Side effects of medications
  • Hypothyroidism
  • Adrenal insufficiency
  • Drug abuse
  • Severe obesity
  • Anorexia nervosa or bulimia
  • Certain mental health conditions such as major depression, bipolar disorder, schizophrenia, delusional disorders, and dementia

Accurate assessment of the causes of chronic fatigue symptoms requires doctors to rule out the above conditions.

Causes of CFS and Chronic Fatigue Symptoms

While the precise causes of CFS elude scientists at this time, some theories do exist. For example, the following causes are possible:

  • Hormone imbalances
  • Viral infections such as glandular fever
  • Bacterial infections like pneumonia
  • Some mental health complications including stress and trauma
  • Immune system difficulties
  • Genetic influences

A major difference between CFS and AFS becomes apparent when discussing causes. Above all, the cause of AFS clearly comes from stress. Stress initiates the symptoms of AFS and your NEM stress response becomes activated to deal with it. CFS is likely to have other causes in addition to or instead of stress.

However, many of the possible causes of CFS listed above also occur in AFS, including hormone imbalances and increased susceptibility to infections. AFS can thus lead to some of the risk factors for CFS, tying the conditions more closely together.


Most people who suffer from CFS encounter their most severe symptoms in the first two years of the condition. However, those who suffer from AFS experience a gradual worsening of symptoms over a long period, often of several years.

After these first two years with CFS, some people recover completely, while a few others may become completely incapacitated. Most people gradually improve over a long period of time but may not ever completely regain their previous capacity. Risk factors for a slower recovery include:

  • Many physical symptoms
  • Chronic depression
  • Older than 40 at the onset of symptoms
  • Suffering from symptoms for a longer period of time

On the other hand, people who suffer from AFS do not recover after a short period of time. Symptoms gradually worsening over years with an accompanying gradual decrease in the ability to function normally. Ultimately, the symptoms of AFS can worsen to the point of the person becoming totally bed bound.

Remediation of CFS and Chronic Fatigue Symptoms

An image of a glass of water on a bedsideOnce your healthcare professional declares you suffer from CFS, the common course of remediation involves a number of approaches. Many of these involve medication. For example, muscle relaxants might be recommended to help you sleep and relax along with stimulants to work on the fatigue. However, this cycle of remediation often does not work.

Three possible outcomes may result from this remediation effort: You may improve; you may reach a plateau of partial relief; or you may receive no relief or even get worse.

Natural Remediation Methods

Some other ways of dealing with your chronic fatigue symptoms also may bring relief. Some of these methods include:

Lifestyle Changes

You may slow down and decrease physical exertion, saving your energy for essential activities at home or work. Avoiding psychological stress also can help.

Gradual Resumption of Exercise

Gradually increasing aerobic exercise very slowly under the guidance of a physical therapist can also help. You may feel worse at times after even low-intensity physical exercise. If this happens, avoid exercise for a few days, then start over at lower intensity.

Get Help For Depression

About 50 to 60 percent of those who suffer from CFS will get some relief if they work to reduce or manage their depression.


  • Some research suggests high doses of Omega-3 fatty acids may bring some relief. They act as modulators of your immune system, enhancing it when needed and inhibiting it when there is too much immune response.
  • Acetyl-L-Carnitine may help as well. Research suggests a deficiency in acylcarnitine intracellularly may bring on some of the fatigue, exercise intolerance, and abnormal heartbeat seen in CFS sufferers. Therefore, an increase in this supplement may lead to an increase in energy for your heart and skeletal muscles.
  • Antioxidants are helpful because CFS produces oxidative stress. These supplements can help protect your cells from free radical damage. They increase mitochondrial function as well.
  • CoQ10 helps produce adenosine triphosphate (ATP), the source of energy for your cells. Therefore, it can reduce fatigue as well as help reduce pain and muscle weakness. In addition, it may also improve cognition. It also works as a scavenger of free radicals and can improve immune function.

Supplementation of any type should always be done with the guidance of an experienced practitioner because supplements could backfire in people with sensitive bodies. This is very common in people with AFS and may be more likely in those with certain types of CFS.


The symptoms of chronic fatigue syndrome are primarily unrelenting fatigue not alleviated by rest or sleep. Sleeplessness becomes problematic, also. A number of other symptoms can also come with the condition.

Many of these symptoms bear great similarity to those of AFS. Because of the difficulty in specifying whether or not you may suffer from CFS, it is important for you and your healthcare professional to consider AFS as an alternative.

However, a significant difference separates the two conditions. No definitive cause for CFS is currently known. But AFS very clearly comes as a result of stress and its effects on your body. The course of the two conditions is another significant difference. With CFS you may experience the worst symptoms in the first two years of the condition, with gradual improvement often following. But with AFS, symptoms gradually worsen over the course of several years.

What Can You Do?

If you are suffering from chronic fatigue symptoms, here are a few things you can do to alleviate the situation:

  • An image of a nurse doing an assessment of a persons musclesMake lifestyle changes to include conserving energy for necessary tasks at home or work.
  • Very gradually resume mild physical exercise under the guidance of a physical therapist.
  • Take supplements like CoQ10, antioxidants, and acetyl-L-carnitine.
  • Consider consulting a healthcare professional with knowledge of AFS.

Whatever course of action you decide to take, however, please do so with the guidance of your healthcare professional. He or she can help you look at options and consider the benefits of each one to bring you the best result.

If you would like to know more about or require assistance with chronic fatigue symptoms, the team at Dr. Lam Coaching can help. We offer a free** no-obligation phone consultation at +1-626-571-1234 where we will privately discuss your symptoms and various options. You can also send us a question through our Ask The Doctor system by clicking here.

© Copyright 2021 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

Chronic fatigue symptoms include the primary symptom of unrelenting fatigue not alleviated by rest or sleep. Sleeplessness may also be a significant symptom. Difficulty with thinking and concentration comes with chronic fatigue syndrome. There also is an impact on self-esteem due to inability to function as previously.

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